Medications for opioid use disorder among American Indians and Alaska natives: Availability and use across a national sample

Background: American Indians and Alaska Natives (AI/ANs) are disproportionately affected by the opioid overdose crisis. Treatment with medications for opioid use disorder (MOUD) can significantly reduce overdose risk, but no national studies to date have reported on the extent to which AI/ANs access these treatments overall and in relation to other groups. Methods: The current study used two national databases - the 2018 National Survey on Substance Abuse Treatment Services and the 2017 Treatment Episode Dataset - to estimate the extent to which MOUD is available and used among AI/ANs across the U.S. Results: We found that facilities serving AI/ANs (N = 1,532) offered some MOUD at similar rates as other facilities (N = 13,277) (39.6 vs. 40.6 %, p = 0.435) but were less likely to offer the standard of care with buprenorphine or methadone maintenance (22.4 % vs. 27.6 %, p < 0.001). AI/AN clients in specialty treatment (N = 8,136) exhibited slightly higher MOUD use (40.0 % vs. 38.6 %, p = 0.009) relative to other race groups (N = 673,938). AI/AN clients were also more likely to exhibit greater prescription opioid use and methamphetamine co-use relative to other groups. AI/AN clients in the South (aOR:0.23[95 %CI: 0.19−0.28] or referred by criminal justice sources (aOR:0.13[95 %CI: 0.11−0.16] were least likely to receive MOUD. Conclusions: We conclude that most AI/ANs in specialty treatment do not receive medications for opioid use disorder, and that rates of MOUD use are similar to those of other race groups. Efforts to expand MOUD among AI/ANs that are localized and cater to unique characteristics of this population are gravely needed.